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    Dependant Card Form 0

    Uploaded by

    Malladi Srinivas
    This document is an application form for an identity card for dependents of ex-servicemen. It collects personal details about the ex-serviceman like name, rank, dates of service and retirement, pension details and address. It also collects details of the dependent like name, relationship to ex-serviceman, date of birth, identification marks and signature. The ex-serviceman declares the details are correct and it is certified by the appropriate authority. Upon approval, an identity card number and validity period are provided.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Dependant Card Form 0

    Uploaded by

    Malladi Srinivas
    771 views1 page
    This document is an application form for an identity card for dependents of ex-servicemen. It collects personal details about the ex-serviceman like name, rank, dates of service and retirement, pension details and address. It also collects details of the dependent like name, relationship to ex-serviceman, date of birth, identification marks and signature. The ex-serviceman declares the details are correct and it is certified by the appropriate authority. Upon approval, an identity card number and validity period are provided.

    Original Description:

    dependent card application form

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    © © All Rights Reserved

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    This document is an application form for an identity card for dependents of ex-servicemen. It collects personal details about the ex-serviceman like name, rank, dates of service and retirement, pension details and address. It also collects details of the dependent like name, relationship to ex-serviceman, date of birth, identification marks and signature. The ex-serviceman declares the details are correct and it is certified by the appropriate authority. Upon approval, an identity card number and validity period are provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    771 views1 page

    Dependant Card Form 0

    Uploaded by

    Malladi Srinivas
    This document is an application form for an identity card for dependents of ex-servicemen. It collects personal details about the ex-serviceman like name, rank, dates of service and retirement, pension details and address. It also collects details of the dependent like name, relationship to ex-serviceman, date of birth, identification marks and signature. The ex-serviceman declares the details are correct and it is certified by the appropriate authority. Upon approval, an identity card number and validity period are provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    APPLICATION CUM RECORD CARD FOR EX-SERVICEMEN DEPENDANT

    IDENTITY CARD Affix Passport


    Annexure II Appendix ‘B’ Of No 01/11 (Reference Para 5) size
    Photograph
    PART-I of Dependent
    PARTICULARS OF EX-SERVICEMEN (OFFICERS/SAILORS)*
    1. Rank: ............. 2. Name...............................3.No ............................
    4. Date of Birth: ....................................................................................
    5. Date Joined Service:.........................................................................
    6. Date of Retirement: ..........................................................................
    7. Pension Payment Order No: ............................................................
    8. Permanent Home Address: ..............................................................
    ..........................................................................................................
    .........................................................................................................
    ..........................................................................................................

    PART-II

    PARTCULARS OF DEPENTDENT

    1. Name: ............................... 2. Sex: ................. 3. D.O.B. ................


    2. Relationship: ....................................................................................
    3. Identification Marks: .........................................................................
    …………………………......................................................................
    4. Signature of Dependent: .................................................................
    5. Left Thumb impression of Dependent: ............................................
    PART-III
    I hereby declare that the particulars given above are true to the best of my
    knowledge.
    Place:
    Date: Signature of Ex-Serviceman
    PART-IV
    It is certified that the particulars mentioned above are correct as per the
    records held.
    DDOP (OA & R)* Commodore*
    IHQ-MOD (Navy) Bureau of Sailors
    New Delhi Mumbai
    (for Officers) (for Sailors)
    Date:-

    PART-V
    Dependent Identity Card No. ...................Valid up to .....................
    Issued on .......................................

    Unit – INS ...................................... (Signature)


    Date: Issuing Authority
    *Delete whichever is not applicable.

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